title: Suppression of ventricular fibrillation by electrical modification of the Purkinje system in hypertrophic cardiomyopathy.
abstract: A 56-year-old man in hypertrophic cardiomyopathy had an electrical storm caused by ventricular fibrillation (VF). Mapping during the initiation of the VF triggered by a premature ventricular contraction (PVC1), with right bundle branch block (RBBB)-like morphology and superior axis, demonstrated a prominent Purkinje-muscle junction (PMJ) delay at the distal portion of the left posterior fascicle. Delivery of radiofrequency (RF) energy to this area abolished the VF triggered by the PVC1. However, VF emerged by triggering another PVC (PVC2) with RBBB-like morphology and inferior axis. Similarly, the initiation of VF was associated with the PMJ delay at the peripheral left anterior fascicle, where RF delivery completely suppressed the VF. The PMJ delay and subsequent Purkinje-muscle reentry-like activity could be essential for the initiation of the Purkinje-related VF.
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan, yokoshh@med.hokudai.ac.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yokoshiki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Mitsuyama
authors.forename: Masaya
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kazuya
authors.initials: K
authors.lastname: Mizukami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D000200:Action Potentials; D002037:Bundle-Branch Block / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000175:diagnosis; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011690:Purkinje Fibers / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D018879:Ventricular Premature Complexes / Q000209:etiology / Q000503:physiopathology / Q000601:surgery